+

WO1998019629A2 - Dispositifs de fixation et de raccord de greffes medicales - Google Patents

Dispositifs de fixation et de raccord de greffes medicales Download PDF

Info

Publication number
WO1998019629A2
WO1998019629A2 PCT/US1997/019946 US9719946W WO9819629A2 WO 1998019629 A2 WO1998019629 A2 WO 1998019629A2 US 9719946 W US9719946 W US 9719946W WO 9819629 A2 WO9819629 A2 WO 9819629A2
Authority
WO
WIPO (PCT)
Prior art keywords
graft
struts
connector
tubular
annular
Prior art date
Application number
PCT/US1997/019946
Other languages
English (en)
Other versions
WO1998019629A3 (fr
Inventor
Thomas J. Bachinski
David S. Goldsteen
Daniel J. Sullivan
Original Assignee
Vascular Science Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US08/745,618 external-priority patent/US5976178A/en
Priority claimed from US08/839,199 external-priority patent/US6036702A/en
Application filed by Vascular Science Inc. filed Critical Vascular Science Inc.
Priority to AU51021/98A priority Critical patent/AU5102198A/en
Priority to DE69732791T priority patent/DE69732791T2/de
Priority to AT97945582T priority patent/ATE290831T1/de
Priority to JP52165298A priority patent/JP4082736B2/ja
Priority to EP97945582A priority patent/EP0951251B1/fr
Publication of WO1998019629A2 publication Critical patent/WO1998019629A2/fr
Publication of WO1998019629A3 publication Critical patent/WO1998019629A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/07—Stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/0058—Flexible endoscopes using shape-memory elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2/064—Blood vessels with special features to facilitate anastomotic coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/954—Instruments specially adapted for placement or removal of stents or stent-grafts for placing stents or stent-grafts in a bifurcation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958—Inflatable balloons for placing stents or stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/061—Blood vessels provided with means for allowing access to secondary lumens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A61F2002/065—Y-shaped blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/3008—Properties of materials and coating materials radio-opaque, e.g. radio-opaque markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2002/826—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents more than one stent being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/848—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
    • A61F2002/8486—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs provided on at least one of the ends
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
    • A61F2002/9511—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument the retaining means being filaments or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2240/00—Manufacturing or designing of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2240/001—Designing or manufacturing processes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0108—Steering means as part of the catheter or advancing means; Markers for positioning using radio-opaque or ultrasound markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M25/09016—Guide wires with mandrils
    • A61M25/09025—Guide wires with mandrils with sliding mandrils

Definitions

  • This invention relates to medical grafting methods and apparatus, and more particularly to methods and apparatus for connecting or fastening tubular bypass grafts.
  • An example of the possible uses of the invention is a minimally invasive cardiac bypass procedure. This example will be considered in detail, but it will be understood that various aspects of the invention have many other possible uses.
  • Several procedures are known for revascularizing the human heart in order to treat a patient with one or more occluded coronary arteries.
  • the earliest of these procedures to be developed involves exposing the heart by means of a midline sternotomy. Following surgical exposure of the heart, the patient's aorta and vena cava are connected to a heart/lung machine to sustain vital functions during the procedure. The beating of the heart is stopped to facilitate performance of the procedure.
  • a suitable blood vessel such as a length of the patient's saphenous (leg) vein is harvested for use as a graft.
  • the graft is used to create a new, uninterrupted channel between a blood source, such as the aorta, and the occluded coronary artery or arteries downstream from the arterial occlusion or occlusions.
  • a blood source such as the aorta
  • the occluded coronary artery or arteries downstream from the arterial occlusion or occlusions A variation of the above procedure involves relocating a mammary artery of the patient to a coronary artery.
  • sternotomy which involves surgical creation of ports in the patient's chest to obtain access to the thoracic cavity. Specially designed instruments are inserted through the ports to allow the surgeon to revascularize the heart without the trauma of a midline sternotomy. Drugs may be administered to the patient to slow the heart during the procedure.
  • Some thoracostomy procedures involve relocating a mammary artery to a coronary artery to provide a bypass around an occlusion in the coronary artery.
  • Thoracostomy bypass procedures are less traumatic than sternotomy bypass procedures, but they are still too traumatic for some patients.
  • the number of required bypasses may exceed the number of mammary arteries, thereby rendering thoracostomy procedures inadequate to fully treat many patients.
  • Another technique for revascularizing the human heart involves gaining access to the thoracic cavity by making incisions between the patient's ribs. This procedure is known as thoracotomy. It is also substantially less traumatic than midline sternotomy, but it is still too traumatic for some patients.
  • a graft e.g., of saphenous vein
  • the graft is typically inserted between two attachment sites in the patient's existing body organs (e.g., between a site along the patient's aorta and a site along the coronary artery downstream from a coronary artery occlusion) .
  • the above-mentioned Goldsteen et al . reference shows, among other things, methods and apparatus for installing tubular bypass grafts intralumenally.
  • the Goldsteen et al . reference shows methods and apparatus in which each end of the graft site is approached separately and intralumenally, penetrated, and then a longitudinal structure (e.g., element 150 in the Goldsteen et al . reference) is established between the ends of the graft site.
  • This longitudinal structure may extend intralumenally all the way out of the patient's body from both ends of the graft site.
  • the graft is fed into the patient's body intralumenally along the longitudinal structure until it is in the desired position extending from one end of the graft site to the other.
  • Each end of the graft is then secured at a respective end of the graft site and the longitudinal structure is withdrawn from the patient .
  • Tubular artificial grafts are needed in various medical procedures. For example, such grafts may be needed to replace diseased or damaged sections of natural tubular body tissue such as in the circulatory system, the urinary tract, etc. Or such grafts may be needed to make new connections in natural tubular body tissue systems such as bypass or shunt connections in the circulatory system. In general, an artificial tubular graft may be needed as either a temporary or permanent installation.
  • apparatus for use as a body tissue graft and methods for securing the graft in a patient comprising a frame structure made of a first elastic material, a covering of a second elastic material on the frame structure, the covering substantially filling openings in the frame structure, and a connector connected to the frame structure.
  • Projections are secured to the connector structure.
  • the projections facilitate attachment of the tubular graft in a patient by securing the graft to the body tissue with which the graft is employed.
  • the connector selectively circumferentially expands and the projections selectively circumferentially expand. This may be done using an inflatable balloon to circumferentially expand the projections and the connector.
  • a restraining member may be provided to restrain the projections in a cone shape so that an end of the graft may be used to open an aperture through a side wall of existing body organ tubing and a portion of the projections may enter the aperture.
  • the connector structures of this invention may be used with artificial grafts having any construction (i.e., other than the frame-and-covering construction mentioned above) , and they may also be used with natural body tissue grafts.
  • FIG. 1 is a simplified longitudinal sectional view showing a portion of an illustrative procedure and related apparatus in accordance with this invention.
  • FIG. 2 is a simplified longitudinal sectional view showing a portion of a more particular illustrative procedure and related apparatus in accordance with the invention.
  • FIG. 3 is a simplified longitudinal sectional view showing an illustrative embodiment of a portion of the FIG. 2 apparatus in more detail.
  • FIG. 4 is a view similar to FIG. 2 showing a later stage in the illustrative procedure depicted in part by FIG. 2, together with related apparatus, all in accordance with this invention.
  • FIG. 5 shows an even later stage in the illustrative procedure depicted in part by FIG. 4, together with related apparatus, all in accordance with this invention.
  • FIG. 6 is a view similar to FIG. 4 showing a still later stage in the illustrative procedure depicted in part by FIG. 5.
  • FIG. 7 is a simplified longitudinal sectional view of an illustrative embodiment of a portion of an illustrative apparatus in accordance with this invention.
  • FIG. 8 is a simplified elevational view of an illustrative embodiment of one component of the FIG. 7 apparatus .
  • FIG. 9 is a simplified longitudinal sectional view of an illustrative embodiment of another portion of the FIG. 7 apparatus.
  • FIG. 10 is a view similar to a portion of FIG. 6 showing an even later stage in the illustrative procedure depicted in part by FIG. 6.
  • FIG. 11 is a view similar to FIG. 10 showing a still later stage in the FIG. 10 procedure.
  • FIG. 12 is a view similar to FIG. 11 showing an even later stage in the FIG. 11 procedure.
  • FIG. 13 is a view similar to another portion of FIG. 6 showing a still later stage in the FIG. 12 procedure.
  • FIG. 14 is a view similar to FIG. 13 showing an even later stage in the FIG. 13 procedure.
  • FIG. 14a is a view similar to FIG. 14 showing a still later stage in the FIG. 14 procedure.
  • FIG. 14b is a view similar to FIG. 14a showing an even later stage in the FIG. 14a procedure.
  • FIG. 15 is a view similar to FIG. 14b showing a still later stage in the FIG. 14b procedure.
  • FIG. 16 is a view similar to FIG. 15 showing an even later stage in the FIG. 15 procedure.
  • FIG. 17 is a simplified longitudinal sectional view of an illustrative embodiment of a portion of more apparatus in accordance with this invention.
  • FIG. 18 is a view similar to FIG. 12 showing a later stage in the FIG. 16 procedure.
  • FIG. 19 is a view similar to FIG. 18 showing a still later stage in the FIG. 18 procedure.
  • FIG. 20 is a view similar to FIG. 16 showing an even later stage in the FIG. 19 procedure.
  • FIG. 21 is a view similar to FIG. 20 showing a still later stage in the FIG. 20 procedure.
  • FIG. 22 is a view similar to FIG. 21 showing an even later stage in the FIG. 21 procedure.
  • FIG. 23 is a view similar to FIG. 6 showing the end result of the procedure depicted in part by FIG. 22.
  • FIG. 24 is a simplified longitudinal sectional view showing an end result similar to FIG. 23 but in a different context.
  • FIG. 25 is a simplified elevational view (partly in section) showing another possible alternative construction of portions of the FIG. 7 apparatus .
  • FIG. 26 is a simplified longitudinal sectional view of the FIG. 25 apparatus in another operating condition.
  • FIG. 26a is a simplified elevational view (partly in section) showing another possible alternative construction of portions of the FIG. 7 apparatus .
  • FIG. 26b is a simplified elevational view of an illustrative embodiment of one component of the apparatus shown in FIG. 26a.
  • FIG. 27 is a simplified end view of an illustrative embodiment of a component of the graft shown in FIGS. 25 and 26.
  • FIG. 28 is an elevational view of a structure that can be used to make a particular embodiment of the apparatus portion shown in FIG. 27.
  • FIG. 29 is a simplified elevational view of a subsequent condition of the FIG. 28 structure during fabrication.
  • FIG. 29a is a simplified enlargement of a portion of FIG. 29 with other components added.
  • FIG. 30 is a simplified longitudinal sectional view showing another possible alternative construction of portions of the apparatus shown in FIG. 7.
  • FIG. 30a is a simplified longitudinal sectional view showing still another possible alternative construction of portions of the apparatus shown in FIG. 7.
  • FIG. 31 is a simplified longitudinal sectional view showing yet another possible alternative construction of portions of the apparatus shown in FIG. 7.
  • FIG. 32 is a simplified longitudinal sectional view showing still another possible alternative construction of portions of the apparatus shown in FIG. 7.
  • FIG. 33 is a view similar to FIG. 13 showing an alternative illustrative embodiment of certain components .
  • FIG. 34 is a view similar to a portion of
  • FIG. 16 for the alternative embodiment shown in FIG. 33.
  • FIG. 34a is another view similar to FIG. 34 showing another alternative illustrative embodiment of the invention.
  • FIG. 34b is an elevational view taken from the right in FIG. 34a.
  • FIG. 35 is a simplified elevational view of apparatus which can be used as an alternative to certain apparatus components shown in FIG. 7.
  • FIG. 36 is a view similar to a composite of FIGS. 7 and 9 showing another alternative illustrative embodiment of certain aspects of the invention.
  • FIG. 37 is a simplified elevational view showing another illustrative embodiment of an artificial graft constructed in accordance with the invention.
  • FIG. 38 is another view similar to FIG. 37 showing another operating condition of the FIG. 37 graft .
  • FIG. 39 is another view similar to FIG. 37 showing the graft being installed in tubular body tissue.
  • FIG. 40 is another view similar to FIG. 39 showing a later stage in the installation of the graft.
  • the procedure may begin by inserting an elongated instrument into the patient's circulatory system so that a distal portion of the instrument extends through the coronary artery narrowing to the vicinity of the point along the artery at which it is desired to make the bypass connection.
  • FIG. 1 shows elongated instrument 100 entering the patient's circulatory system 10 at a remote location 12 and passing coaxially along vessels in the circulatory system until its distal end portion 104 passes through narrowing 22 in coronary artery 20 and reaches the downstream portion 24 of the artery to which it is desired to make a bypass connection.
  • the entry location 12 of instrument 100 may be a femoral (leg) artery of the patient, a brachial artery of the patient, or any other suitable entry point. It will be appreciated, however, that entry point 12 is typically remote from the location at which the bypass is to be provided, and that control of instrument 100 throughout its use is from the proximal portion 102 that is outside the patient at all times.
  • FIG. 2 shows a preferred embodiment of instrument 100 in more detail.
  • instrument 100 may include a catheter tube 110 which is inserted (from location 12 in FIG. 1) via the patient's aorta 30 to the ostium of coronary artery 20.
  • tubular structure 120 is then extended from the distal end of catheter 110, through narrowing 22 to location 24.
  • An illustrative construction of tubular structure 120 is shown in more detail in FIG. 3.
  • structure 120 may have two lumens 130 and 140. Near the distal end of structure 120, lumen 130 communicates with the interior of an inflatable balloon 132 on one side of structure 120, while lumen 140 opens out to the opposite side of structure 120.
  • Lumen 140 contains a longitudinal structure 150 which may be a stylet wire with a sharpened distal tip 152.
  • Structure 120 may be provided with a distal spring tip 122 to help guide the distal end of structure 120 along coronary artery 20 and through narrowing 22.
  • a safety ribbon 123 (e.g., of the same material as tip 122) may be connected at its proximal end to the distal end of member 120 and at its distal end to the distal end of tip 122 to improve the performance of tip 122 and to help prevent separation of any portion of tip 122 from structure 120 in the event of damage to tip 122.
  • Structure 120 may have radiologic (e.g., radio-opaque or fluoroscopically viewable) markers 124 at suitable locations to help the physician place the structure where desired in the patient's body.
  • Catheter 110 may also have radiologic markers 112 for similar use.
  • Balloon 132 is initially deflated. Longitudinal structure 150 is initially retracted within lumen 140.
  • distal portion of lumen 140 is shaped (as indicated at 142 in FIG. 2) to help guide the distal tip 152 of structure 150 out to the side of structure 120 when structure 150 is pushed distally relative to structure 120. This is discussed in more detail below.
  • each of components 110, 120, and 150 is separately controllable from outside the patient, generally indicated as region 102 in FIG. 1.
  • a second elongated instrument 200 is similarly introduced into the patient's circulatory system 10.
  • instrument 200 may enter the patient via a femoral artery, a brachial artery, or any other suitable location, which again is typically remote from the bypass site. If one femoral artery is used to receive instrument 100, the other femoral artery may be used to receive instrument 200. Or the same femoral artery may be used to receive both instruments. Or any other combination of entry points may be used for the two instruments.
  • Instrument 200 is inserted until its distal end is adjacent to the point 34 in the circulatory system which it is desired to connect to point 24 via a bypass. This is illustrated in FIG.
  • FIG. 4 shows portions of instruments 100 and 200 side by side in aorta 30.
  • the next step in the illustrative procedure being described is preferably to deploy a snare loop 354 (FIG. 5) from the distal end 204 of instrument 200 through the aorta wall to a location outside the coronary artery wall adjacent coronary artery portion 24.
  • a snare loop 354 FIG. 5
  • stylet wire 150 is moved in the distal direction so that its distal tip 152 passes through the wall of the coronary artery.
  • the distal end of the stylet wire lumen in tube 120 is shaped to help guide stylet wire 150 through the coronary artery wall.
  • snare sheath or lumen 340 is moved distally relative to the snare loop as shown in FIG. 5. This causes snare loop 354 to close down on wire 150. Snare sheath or lumen 340 also tends to trap the distal portion of wire 150 and to fold that wire portion back on itself inside sheath or lumen 340. The longitudinal structures 150 and 350 are securely interengaged inside snare sheath or lumen 340. The next step is to pull snare wire 352 in the proximal direction all the way out of the patient. Because of the interengagement between wires 150 and 352, withdrawing wire 352 pulls as much additional wire 150 into the patient from external location 102 (FIG.
  • wire 352 has been completely removed from the patient, there is then one continuous wire 150 from outside the patient at 102, through the patient, to outside the patient again.
  • Wire 150 can now be moved in either longitudinal direction through the patient.
  • This wire or another wire could be used to help pull various apparatus into the patient via the tube or tubes through which the wire passes.
  • the other snare components such as 340 may be withdrawn from the patient by pulling them proximally out of catheter 210.
  • the condition of the apparatus inside the patient is now as shown in FIG. 6. Note that the presence of fixed outlets for the wire from the distal portion of tube 120 and the distal end of catheter 210 prevents wire 150 from cutting tissues 20 and 30 when the wire is pulled in either longitudinal direction.
  • the portion of wire 150 extending through the interior of the patient between elements 120 and 210 may have radiologic markers 154 equally spaced along its length. These can be viewed radiologically by the physician to determine the distance between regions 24 and 34 via wire 150. This helps the physician select the correct length of graft needed between regions 24 and 34.
  • the next phase of the illustrative procedure being described is to install a new length of tubing or graft between regions 24 and 34.
  • the new length of tubing may be either an artificial graft, natural body organ tubing harvested from the patient's body, or a combination of artificial and natural tubing (e.g., natural tubing coaxially inside artificial tubing) .
  • the new tubing is to be natural tubing (e.g., a length of the patient's saphenous vein that has been harvested for this purpose) inside an artificial conduit.
  • both conduits can be delivered and installed simultaneously, or the outer artificial conduit can be delivered and installed first, and then the inner natural conduit can be delivered and installed.
  • both conduits can be delivered and installed simultaneously, or the outer artificial conduit can be delivered and installed first, and then the inner natural conduit can be delivered and installed.
  • the latter technique is employed.
  • FIG. 8 An illustrative embodiment of an artificial graft 430 is shown in FIG. 8.
  • any suitable construction can be used for the main portion of graft 430, a particularly preferred construction is shown and described in the above-mentioned Goldsteen et al. reference.
  • this graft construction may include a tubular mesh framework 432 of nitinol covered with silicone 434 to substantially fill in the interstices in the framework. Additional details, features, and alternatives regarding this type of graft construction will be found in the above-mentioned Goldsteen et al. reference, and in Bachinski et al .
  • Grafts having this type of construction are extremely elastic and they can be radically deformed without damage or permanent change in shape.
  • a graft of this construction can be stretched to a small fraction of its original diameter, and it thereafter returns by itself to its original size and shape without damage or permanent deformation of any kind.
  • Grafts of this type can be made with any desired porosity (e.g., through the silicone) .
  • they can also be made so that they pulse in response to pressure pulses in the blood flowing through them, very much like the pulsation of natural blood vessels. This can be important to discouraging the formation of clots in the graft.
  • assembly 400 includes a threaded, conical, distal tip 412 mounted on a tubular member 410 (e.g., metal hypotube) through which wire 150 can freely pass. It should be mentioned here that in this embodiment tip 412 is selectively collapsible to facilitate its withdrawal from the patient after it has served its purpose.
  • a tubular member 410 e.g., metal hypotube
  • An inflatable balloon 422 is mounted on the distal end of tubular member 420.
  • Tubular member 420 includes an axially extending lumen (not shown in FIG. 7) for use in selectively inflating and deflating balloon 422.
  • Balloon 422 is shown deflated in FIG. 7.
  • Coaxially around tubular member 420 is artificial graft conduit 430.
  • an illustrative embodiment of a suitable graft conduit 430 is shown in FIG. 8 and includes a tube formed of a frame 432 of a first highly elastic material (such as nitinol) with a covering 434 of a second highly elastic material (e.g., a rubber-like material such as silicone) substantially filling the apertures in the frame.
  • a second highly elastic material e.g., a rubber-like material such as silicone
  • the struts 436 may have hooks and/or barbs disposed thereon.
  • two axially spaced resilient flaps 438a and 438b with prongs 439 are provided.
  • conduit delivery tube 440 which coaxially surrounds conduit 430.
  • conduit 430 may be somewhat circumferentially compressed by tube 440.
  • FIG. 9 The portion of assembly 440 at which the proximal end of conduit 430 is located is shown in FIG. 9. There it will be seen how flaps 438 are confined within conduit delivery tube 440. FIG. 9 also shows how tubes 410, 420, and 440 extend proximally (to the right as viewed in FIG. 9) from the proximal end of conduit 430 so that the physician can remotely control the distal portion of assembly 400 from outside the patient.
  • assembly 400 is fed into the patient along wire 150 through catheter 210.
  • tip 412 reaches coronary artery portion 24, tip 412 is threaded into and through the coronary artery wall by rotating tube 410 and therefore tip 412. (Tube 120 may be pulled back slightly at this time to make sure that it does not obstruct tip 412.)
  • the passage of tip 412 through the coronary artery wall opens up the aperture in that wall.
  • that wall seals itself against the outside of the distal portion of conduit delivery tube 440 as shown in FIG. 10.
  • the next step is to push tube 410 and tip 412 distally relative to delivery tube 440, which is held stationary.
  • Conduit 430 is initially moved distally with components 410 and 412. This may be done by inflating balloon 422 so that it engages conduit 430, and then moving tube 420 distally with components 410 and 412. Distal motion of conduit 430 moves struts 436 beyond the distal end of delivery tube 440, thereby allowing the struts 436 to spring out inside coronary artery 20 as shown in FIG. 11. This prevents the distal end of conduit 430 from being pulled proximally out of the coronary artery. If balloon 422 was inflated during this phase of the procedure, it may be deflated before beginning the next phase.
  • the next step is to pull delivery tube 440 back slightly so that it is withdrawn from coronary artery 20. Then tube 420 is moved distally so that balloon 422 is radially inside the annulus of struts 436. Balloon 442 is then inflated to ensure that struts 436 (and barbs and/or hooks if provided) are firmly set in coronary artery 20. Conditions are now as shown in FIG. 12. Cross sections of balloon 422 may be L-shaped when inflated (one leg of the L extending parallel to the longitudinal axis of conduit 430, and the other leg of the L extending radially outward from that longitudinal axis immediately distal of struts 436) . This may further help to ensure that struts 436 fully engage the wall of coronary artery 20. The next step is to deflate balloon 422.
  • delivery tube 440 is withdrawn proximally until flap 438a (but not flap 438b) is distal of the distal end of the delivery tube. This allows flap 438a to spring radially out as shown in FIG. 13.
  • Tube 420 is then withdrawn until balloon 422 is just distal of flap 438a. Then balloon 422 is inflated, producing the condition shown in FIG. 13.
  • next steps are (1) to deflate distal balloon 214, (2) to proximally withdraw catheter 210 a short way, (3) to proximally withdraw tube 420 to press flap 438a against the outer surface of the aorta wall, and (4) to proximally withdraw delivery tube 440 by the amount required to allow flap 438b to spring out against the interior of catheter 210, all as shown in FIG. 14.
  • the prongs 439 on flap 438a are urged to enter the aorta wall tissue to help maintain engagement between flap 438a and the wall of the aorta.
  • Inflated balloon 422 helps to set prongs 439 in the tissue when tube 420 is tugged proximally.
  • the next step is to insert the distal portion of delivery tube 440 into the proximal end of conduit 430 as shown in FIG. 14a.
  • the distal end of conduit 430 may be inserted all the way to the proximal end of balloon 422 (see FIG. 15 for a depiction of this) .
  • a purpose of this step is to subsequently help control the rate at which blood is allowed to begin to flow through conduit 430.
  • the next step is to proximally withdraw catheter 210 by the amount required to release flap 438b to spring out against the interior of the wall of aorta 30 as shown in FIG. 14b.
  • Catheter 210 may be subsequently pushed back against flap 438b as shown in FIG. 15 to help securely engage that flap against the aorta wall.
  • natural body conduit e.g. a length of the patient's saphenous vein that has been harvested for this purpose
  • artificial conduit 430 After installation of the latter conduit.
  • An illustrative assembly 500 for delivering a length of natural body conduit to installed conduit 430 is shown in FIG. 17.
  • assembly 500 includes a tube 510 disposed around wire 150 so that tube 510 is freely movable in either direction along wire 150.
  • Tube 510 has an inflatable annular balloon 512a near its distal end and another inflatable annular balloon 512b spaced in the proximal direction from balloon 512a.
  • Tube 510 includes separate inflation lumens (not shown) for each of balloons 512 so that the balloons can be separately inflated and deflated.
  • An annular collar structure or ring 520a is disposed concentrically around balloon 512a, and a similar annular collar structure or ring 520b is disposed concentrically around balloon 512b.
  • Balloons 512 may be partly inflated.
  • Each of rings 520 may have radially outwardly extending prongs 522.
  • the rings 520 may alternatively or additionally be fluted or provided with raised portions (alternatives that are discussed below (e.g., in connection with FIGS. 27-29a and 36)).
  • a length of natural body conduit 530 e.g., saphenous vein as mentioned earlier
  • Prongs 522 may extend through the portions of conduit 530 that axially overlap rings 520.
  • a delivery tube 540 is disposed around conduit 530. In use, tubes 510 and 540 extend proximally (to the right as viewed in FIG. 17) out of the patient to permit the physician to remotely control the distal portion of assembly 500.
  • the rings 520 may be provided with fluted or raised structures that grip the graft conduit 430.
  • balloons 512 may be on a relatively small first tube, while balloon 512b is on a larger second tube that concentrically surrounds the proximal portion of the first tube.
  • the first and second tubes are axially movable relative to one another, thereby allowing the distance between balloons 512 to be adjusted for grafts 530 of different lengths.
  • An illustrative apparatus of this kind is shown in Goldsteen et al. U.S. patent application No. 08/839,298, filed April 17, 1997, which is hereby incorporated by reference herein.
  • Assembly 500 is employed by placing it on wire 150 leading into catheter 210. Assembly 500 is then advanced distally along wire 150 through catheter 210 and then into conduit 430 until the distal end of conduit 530 is adjacent the distal end of conduit 430 and the proximal end of conduit 530 is adjacent the proximal end of conduit 430. The condition of the apparatus at the distal end of assembly 500 is now as shown in FIG. 18. The condition of the apparatus at the proximal end of conduit 530 is as shown in FIG. 20.
  • the next step is to proximally withdraw delivery tube 540 so that the distal portion of conduit 530 and distal ring 520a are no longer inside the distal portion of delivery tube 540.
  • distal balloon 512a is inflated to circumferentially expand ring 520a and to set prongs 522 through conduit 530 into the surrounding portion of conduit 430 and coronary artery wall portion 24.
  • FIG. 19 shows the condition of the apparatus at this stage in the procedure.
  • the next step is to continue to proximally withdraw delivery tube 540 until the proximal end of conduit 530 and proximal ring 520b are no longer inside tube 540 (see FIG. 21) .
  • proximal balloon 512b is inflated to circumferentially expand ring 520b and thereby set prongs 522 through conduit 530 into the surrounding portion of conduit 430 and aorta wall portion 34 (see FIG. 22) .
  • This provides a completed anastomosis of the proximal end of conduit 530 to aorta 30.
  • the next step is to deflate balloons 512a and
  • the bypass that is left in the patient is as shown in FIG. 23. This bypass extends from aorta 30 at location 34 to coronary artery 20 at location 24.
  • the bypass includes natural body conduit 530 inside artificial graft conduit 430. One end of the bypass is anchored and anastomosed to coronary artery 20 by prongs 436 and ring 520a.
  • bypass 620 is a same-vessel bypass around a narrowing 612 in vessel 610.
  • FIGS. 25 and 26 Another illustrative alternative embodiment of some of the instrumentation shown in FIG. 7 is shown in FIGS. 25 and 26.
  • FIGS. 25 and 26 use reference numbers with primes for elements that are generally similar to elements identified by the corresponding unprimed reference numbers in FIG. 7.
  • Each axial end portion of graft 430 includes a radially enlargeable connector structure 449.
  • Connector structures 449 may have any of a large number of constructions.
  • each connector structure 449 may include one or more annularly compressible, serpentine-shaped, metal rings 448 (e.g., of nitinol) .
  • metal rings 448 e.g., of nitinol
  • graft 450 is made of a metal (e.g., nitinol) framework 432 with a covering 434 (e.g., of silicone)
  • rings 448 may be integral with framework 432, and covering 434 may continue into the vicinity of rings 448.
  • Rings 448 may be formed to hold struts 436' substantially uniformly out against the inner surface of body tubing all the way around the circumference of the graft.
  • a particularly preferred way of producing a serpentine ring 448 is to start with a short length of thin-walled metal tubing 460 as shown in FIG. 28 and cut away interdigitated portions 462 from opposite axial ends of the tube as shown in FIG. 29.
  • a typical thickness of tubing 460 is approximately 0.003 to 0.006 inches, and a typical width of metal left between adjacent slots 462 is about 0.008 inches.
  • Slots 462 may be cut in tubing 460 using a laser.
  • the structure shown in FIG. 29 is then radially enlarged and annealed. In its radially enlarged form, the structure has the general appearance shown in FIG. 27 when viewed from an axial end. Each point 458 is adjacent an axial end of the original tube 460.
  • the structure can be resiliently radially compressed to the size of the original tube 460 or an even smaller size, and it will return to the radially enlarged size and shape whenever released from radial compression.
  • Points 458 form radially outwardly extending high spots or raised portions that help ring 448 securely engage surrounding body tissue by locally projecting to a greater extent into the tissue, even though points 458 may not actually penetrate the tissue.
  • some or all of the desired circumferential expansion of such a ring may be produced by inflating balloon 422' or using another selectively radially enlargeable structure inside the ring to plastically deform the ring.
  • each strut may be connected (e.g., welded) to a peak of the serpentine structure as shown for example in FIG. 29a. This may be done at any convenient time (e.g., before circumferential expansion of the FIG. 29 structure) .
  • a ring 448 made as described above in connection with FIGS. 27-29a may be somewhat ribbon-like (e.g., because the width of the metal between slots 462 is greater than the thickness of that metal) .
  • the material in the peaks 458 of the convolutions tends to twist. This can give these peaks a shape which is especially effective in engaging adjacent body tissue. If struts like 436' are attached to these peaks as shown in FIG.
  • the twisting of the peak material can be used to similarly twist the struts (e.g., to bias them in favor of radial outward projection and/or to rotate them about their longitudinal axes to properly orient hooks and/or barbs on them) .
  • struts 436' are connected to the distal end of the serpentine ring 448 of the connector 449, which is connected in turn to the distal end of frame 432'.
  • Struts 436' are initially held in the form of a distally pointed cone by yieldable bands 437a, 437b, 437c, and 437d.
  • bands 437 may be made of a polymeric or other suitable yieldable material. Alternatively, bands 437 could be serpentine metal members that yield by becoming straighter. Bands 437 are initially strong enough to prevent struts 436' from flaring radially outward from conduit 430' as the struts are resiliently biased to do. However, bands 437 can be made to yield by inflating balloon 422' (on the distal end of tube 420') inside the annulus of struts 436'.
  • Struts 436' can be forced through tissue such as the wall of coronary artery 20 in their initial cone shape. Sufficient pushing force can be applied to the cone of struts 436' in any of several ways.
  • tube 420' may be metal (e.g., stainless steel) hypo-tube which can transmit pushing force to the cone of struts 436' by inflating balloon 422' to trap the base of the cone between balloon 422' and tube 440. Additional pushing force may then also be applied via tube 440 itself.
  • bands 437 may be made progressively weaker in the distal direction to facilitate prompt yielding of distal bands such as 437a and 437b in response to relatively little inflation of balloon 422', whereas more proximal bands such as 437c and 437d do not yield until somewhat later in response to greater inflation of balloon 422'. This progression of yielding may help ensure that the annulus of barbs flares out in the desired trumpet-bell shape inside the coronary artery.
  • struts 436' are initially held in the form of a distally pointed cone by a yieldable cone 441 which is attached to or is part of tube 440.
  • Cone 441 may be made of a polymeric or other suitable yieldable material. Cone 441 is initially strong enough to prevent struts 436' from flaring radially outward from conduit 430' as the struts 436' are resiliently biased to do.
  • cone 441 can be made to yield by inflating balloon 422' (on the distal end of tube 420') inside the annulus of struts 436' .
  • Struts 436' can be forced through tissue such as the wall of coronary artery 20 in their initial cone shape.
  • tube 420' may be metal (e.g., stainless steel) hypotube which can transmit pushing force to the cone of struts 436' by inflating balloon 422' to trap the base of the cone between balloon 422' and tube 440. Additional pushing force may then also be applied via tube 440 itself.
  • metal e.g., stainless steel
  • cone 441 When a sufficient portion of the height of the cone of struts 436' is through the coronary artery wall, balloon 422' is inflated inside the cone as shown in FIG. 26a to cause cone 441 to yield. This allows struts 436' to flare radially outward inside the coronary artery, thereby anchoring the distal end of conduit 430' to the artery. Cone 441 may be made progressively weaker in the distal direction to facilitate prompt yielding of distal end in response to relatively little inflation of balloon 422', whereas the more proximal end does not yield until somewhat later in response to greater inflation of balloon 422'. This progression of yielding may help ensure that the annulus of struts 436' flares out in the desired trumpet-bell shape inside the coronary artery. The cone 441 may be withdrawn with the tube 440, and may even be made part of tube 440.
  • FIG. 26b depicts tube 440 and cone 441 by themselves in order to better show that cone 441 may have a weakened zone 441a extending in the distal direction to help the cone yield to deploy struts 436' when balloon 422' is inflated.
  • Weakened zone 441a can be a slit, a score line, a perforation line or any other generally similar structural feature.
  • FIG. 30 Still another illustrative alternative embodiment of some of the instrumentation shown in FIG. 7 is shown in FIG. 30.
  • FIG. 30 uses reference numbers with double primes for elements that are generally similar to elements identified by the corresponding unprimed reference numbers in FIG. 7.
  • the distal end of artificial graft conduit 430" is attached to expandable ring 448.
  • Elongated struts 436" extend distally from the distal end of ring 448.
  • the distal ends of struts 436" are turned back in the proximal direction and extend just far enough into the distal end of tube 420" to be releasably retained by that tube.
  • Struts 436" are resiliently biased to extend radially outward from ring 448, but are initially restrained from doing so by the presence of their distal end portions in the distal end of tube 420".
  • struts 436" initially form a distally pointing cone that can be pushed through tissue such as the wall of coronary artery 20 in the same manner that has been described above in connection with FIGS. 25 and 26.
  • Structure 420 which may be metal (e.g., stainless steel) hypotube with an inflatable annular balloon 422" near its distal end, may be used to help push the cone through the tissue.
  • each of struts 436" may be twisted 180° before it enters the distal end of tube 420". This promotes turning of the hook-like extreme distal end portions of the struts toward the coronary artery wall when the struts are released from tube 420".
  • Ring 448 and struts 436" may be made of any suitable material such as any 300-series stainless steel (e.g., 316L stainless steel). Another material that may be suitable for struts 436" is nitinol.
  • the elastic cover 434 that forms part of conduit 430" preferably extends to regions 430a and 436".
  • the struts 436" are attached to ring 448 at the closest (distal-most) points of the ring 448. This causes the struts 436" to pull in the proximal direction when the ring 448 is expanded by balloon 422". This causes the hooks on the ends of the struts to pull into the surrounding tissue for a more secure attachment.
  • the hooks on the ends of struts 436" may also have barbs formed thereon for an even more secure attachment to body tissue.
  • outer struts 435 which are attached to the farthest
  • FIG. 31 Still another illustrative alternative embodiment of some of the instrumentation shown in FIG. 7 is shown in FIG. 31.
  • the distal end of artificial graft conduit 430 is attached to expandable ring 448.
  • Elongated struts 436 extend distally from the distal end of ring 448.
  • the distal ends of struts 436 have hooks 466 having small barbs 467 at the ends.
  • the struts 436 are turned back in the proximal direction.
  • Struts 436 are resiliently biased to extend radially outward from ring 448, but they are initially restrained from doing so by the presence of their distal end portions wrapped by a restraining wire 465.
  • struts 436 initially form a distally pointing cone that can be pushed through tissue such as the wall of coronary artery 20 in the same manner that has been described above.
  • the wire 465 which may be metal (e.g., stainless steel), is then pulled back proximally to unwrap the distal portion from around the struts.
  • This allows struts 436 to spring radially outwardly from ring 448 inside coronary artery 20, thereby anchoring the distal end of the graft conduit in the coronary artery using the hooks 466 and barbs 467.
  • Ring 448 can be circumferentially expanded at any suitable time to increase the size of the connection between coronary artery 20 and the distal portion of the graft conduit 430.
  • FIG. 32 shows a variation of the FIG. 31 apparatus.
  • struts 436" are initially restrained by a loop or coil on the distal end of wire 465".
  • Wire 465" extends distally from a lumen in the wall of tube 420.
  • tube 420 is rotated about its central longitudinal axis. This rotates the loop or coil in wire 465", thereby releasing struts 436" one after another.
  • wire 465" may be proximally retracted relative to tube 420 so that the loop in wire 465" is adjacent the distal end of that tube.
  • wire 465" may be proximally retracted all the way into the lumen in the wall of tube 420 from which the wire initially extends .
  • FIG. 33 An alternative construction of the proximal end of artificial graft conduit 430 is shown in FIG. 33.
  • the embodiment shown in FIG. 33 can be used with any construction of the distal end of conduit 430, but FIG. 33 assumes that the depicted proximal end construction is used with a distal end construction of any of the types shown in FIGS. 25-26a and 30-32.
  • the proximal end of conduit 430 has a plurality of struts 1436 that are resiliently biased to extend radially out from the remainder of the conduit. Initially, however, struts 1436 are confined within delivery tube 440 as shown in FIG. 33.
  • struts 1436 may be proximal extensions of the frame 432 of conduit 430, or they may extend proximally from a ring at or near the proximal end of conduit 430. This proximal ring may be similar to distal ring 448 described above in connection with FIGS, like FIG. 25.
  • the covering 434 of conduit 430 may extend to all, part, or none of the length of struts 1436.
  • Struts 1436 may include resilient hooks, and the free end portions of struts 1436 or the hooks on those struts may include barbs. Representative struts 1436, each with a hook 1466 and a barb 1467, are shown after deployment and in more detail in FIG. 34.
  • FIG. shows that struts 1436 flare out inside aorta 30 and that the free ends of hooks 1466 penetrate the aorta wall tissue shown at 34. Barbs 1467 engage the tissue like fish hook barbs to resist any tendency of hooks 1466 to pull out of the tissue.
  • conduit 430 is attached to the wall of aorta 30 (after attachment of the distal end to coronary artery 20 as described above in connection with numerous other FIGS.) by proximally retracting delivery tube 440 so that struts 1436 can spring out against the inside of catheter 210 in the vicinity of proximal balloon 212. Then distal balloon 214 is deflated and catheter 210 is retracted proximally so that struts 1436 can spring out against the inside surface of the wall of aorta 30 as is generally shown in FIG. 34. If provided, hooks 1466 and barbs 1467 penetrate the aorta tissue as shown in FIG. 34.
  • proximally retract the balloon 422/422 ' /422" (described above in connection with numerous other FIGS.) to the proximal end of conduit 430 and to there re-inflate the balloon to help hold conduit 430 in place before proximally retracting delivery tube 440.
  • the balloon can be deflated again at any suitable time (e.g., after delivery tube 440 has been proximally retracted).
  • Balloon 422/422 ' /422" may additionally or alternatively be inflated during proximal retraction of catheter 210.
  • FIGS. 34a and 34b Possible refinements of a proximal connector of the general type shown in FIGS. 33 and 34 are shown in FIGS. 34a and 34b.
  • FIGS. 34a and 34b show the connector fully installed though an aperture in body tissue wall 34.
  • Artificial graft conduit 430 is formed so that its proximal portion is resiliently biased to assume the shape shown in FIGS. 34a and 34b. In particular, this shape includes a medial, radially outwardly projecting, annular flange 430a, and a proximal, radially outwardly projecting, annular flap 430b.
  • Flange 430a is intended to be deployed outside body tissue wall 34 as shown in FIG.
  • a connector 449 (similar to the connectors 449 in earlier-described FIGS, such as FIGS. 25-30, 31, and 32) is provided adjacent flap 430b.
  • Connector 449 includes a radially expandable serpentine ring 448 and a plurality of struts 436 which are resiliently biased to project radially outwardly.
  • struts 436 pass through the structure of flap 430b to help push the flap up inside and against the inner surface of tissue wall 34.
  • the structure shown in FIGS. 34a and 34b may be delivered to the intended location in the body inside a delivery tube (e.g., like tube 440 in FIG. 33). While the structure is inside the delivery tube, all of elements 430a, 430b, and 436 are constrained by that tube into a substantially tubular shape. When the delivery tube is proximally retracted from conduit 430, elements 430a, 430b, and 436 resiliently return to the shapes shown in FIGS. 34a and 34b, thereby making a secure and fluid- tight connection between the proximal end of conduit 430 and body tissue wall 34.
  • a delivery tube e.g., like tube 440 in FIG. 33.
  • FIG. 35 illustrates another possible use of the connecting structures as described above, as well as illustrating other possible aspects of the invention.
  • FIG. 35 illustrates a structure that can be used to deliver an artificial graft conduit, or a natural graft conduit, or both an artificial graft conduit and a natural graft conduit simultaneously (e.g., with the natural conduit coaxially inside the artificial conduit) .
  • an artificial graft conduit or a natural graft conduit, or both an artificial graft conduit and a natural graft conduit simultaneously (e.g., with the natural conduit coaxially inside the artificial conduit) .
  • FIG. 35 it is assumed that only natural graft conduit is being delivered, but it will be readily apparent that artificial graft conduit could be substituted for or added outside the natural graft conduit.
  • the cone of struts 436' is attached to the distal end of a natural graft conduit 530.
  • the proximal end of natural graft conduit 530 is attached to ring 461.
  • the cone of struts 436' is provided with relatively short, radially outwardly projecting prongs 433.
  • Prongs 433 extend into and/or through the distal portion of the length of graft tubing 530, which (as has been mentioned) is assumed in this case to be natural body organ tubing such as saphenous vein.
  • Ring 461 is similarly provided with radially outwardly extending prongs 462, which extend into and/or through the proximal portion of graft conduit 530.
  • Ring 461 also includes resilient radially outwardly extending annular flaps 438a and 438b with prongs 439, all similar to correspondingly numbered elements in FIG. 8.
  • Structure 420' is disposed around wire 150 inside structures 436', 450, 460, and 530.
  • Delivery tube 440 is disposed around conduit 530.
  • the embodiment shown in FIG. 35 illustrates a structure which can be used to deliver and install natural body organ conduit without any full length artificial graft conduit being used. In a manner similar to what is shown in the previous FIGS., the structure shown in FIG. 35 is delivered to the operative site via wire 150.
  • the cone of struts 436' is forced through the wall of coronary artery 20 and then flared radially outward inside the coronary artery to anchor the distal end of the graft conduit to that artery.
  • the distal end of delivery tube 440 is pulled back as needed to aid in attachment of the distal end of the graft structure. Attachment of the proximal end of the graft structure to the wall of aorta 30 is performed similarly to what is shown in the above FIGS. Accordingly, with distal flap 438a just outside the wall of aorta 30, delivery tube 440 is pulled back proximally to expose that flap. Flap 438a is thereby released to spring out and engage the outer surface of the aorta wall.
  • proximal flap 438b is adjacent the inner surface of the aorta wall.
  • Tube 440 is pulled back proximally even farther to expose flap 438b so that it can spring out and engage the inner surface of the aorta wall.
  • Natural body organ graft 530 is now fully installed in the patient. Struts 436', 450, and 460 remain in place in the patient to help anchor the ends of graft conduit 530 and to help hold open the medial portion of that conduit . - 3 f
  • FIG. 36 shows an alternative to what is shown in FIG. 35.
  • a distal annular connector structure 449a is annularly attached to the distal end of conduit 530 (similar to conduit 530 in FIG. 35), and a proximal annular connector structure 449b is annularly attached to the proximal end of conduit 530.
  • each of connectors 449 may be sutured to the respective end of conduit 530.
  • connectors 449 may be inside or outside conduit 530.
  • Each of connectors 449 may be similar to the connectors 449 in earlier-described FIGS, such as FIGS. 25-30, 31, and 32.
  • each of connectors 449 includes a serpentine ring 448 with a plurality of struts 436 extending from the ring.
  • the ring 448 of each connector may be inside the conduit and the high spots 458 (FIG. 27) on the ring may be used to dig into the tissue of conduit 530 (without actually penetrating the tissue) to secure or help secure the connector to the tissue.
  • the struts 436a of distal connector 449a extend in the distal direction from ring 448a and are initially restrained into a cone shape by a release wire 465 as shown in FIG. 31.
  • the struts 436b of proximal connector 449b extend in the proximal direction from ring 448b and are initially constrained by being inside delivery tube 440.
  • the struts 436a of distal connector 448a are deployed to spring radially outwardly and engage body tissue by proximally retracting release wire 465.
  • the struts 436b of proximal connector 448b are deployed to spring radially outwardly and engage body tissue by proximally retracting delivery tube 440.
  • the structure shown in FIG. 36 can be used in any of the ways that are described above for the structure shown in FIG. 35.
  • FIG. 37 shows a structure that may be used as an alternative to the embodiments described above. For example, structures like this may be used in place of the connectors using barbs, or wherever else a generally similar connecting structure is needed.
  • a T- flange connector 700 is provided. It is constructed generally similar to the graft conduits 430 described above, having a frame, and a covering.
  • the connector 700 is formed in the shape of a "T" of hollow tubular sections and is resiliently biased to return to this shape.
  • the connector is initially deployed with one of the ends 702 of the top of the "T” inverted or compressed into the other end 704 of the top of the "T” as shown in FIG. 38.
  • the compressed connector is then deployed using a tube 440 as described above.
  • the connector 700 expands to its original "T” shape.
  • the top of the "T” may be inserted into coronary artery 20 through an aperture in the side wall of that artery as shown in FIG. 39.
  • one leg 704 of the top of the “T” extends upstream along the coronary artery, and the other leg 702 extends downstream along that artery as shown in FIG. 40.
  • the remainder of the "T” i.e., the "vertical” portion of the "T" extends out of the aperture in the coronary artery so that the base of the "T” can be connected to the aorta (e.g., using any of the other connector structures and techniques described above) .
  • references to a patient's existing body organ tubing or the like include both natural and previously installed graft tubing (whether natural, artificial, or both) .
  • the artificial grafts of this invention may be coated (in the case of tubular grafts, on the inside and/or outside) to still further enhance their bio-utility.
  • suitable coatings are medicated coatings, hydrophylic coatings, smoothing coatings, collagen coatings, human cell seeding coatings, etc.
  • the above-described preferred porosity of the graft covering helps the graft to retain these coatings.
  • Additional advantages of the artificial grafts of this invention are their elasticity and distensibility, their ability to be deployed through tubes of smaller diameter (after which they automatically return to their full diameter) , the possibility of making them modular, their ability to accept natural body organ tubing concentrically inside themselves, their ability to support development of an endothelial layer, their compatibility with MRI procedures, their ability to be made fluoroscopically visible, etc.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Vascular Medicine (AREA)
  • Surgery (AREA)
  • Transplantation (AREA)
  • Pulmonology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Molecular Biology (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Biophysics (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Pathology (AREA)
  • Optics & Photonics (AREA)
  • Physics & Mathematics (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Prostheses (AREA)
  • Ink Jet Recording Methods And Recording Media Thereof (AREA)
  • Surgical Instruments (AREA)
  • Electrotherapy Devices (AREA)
  • Materials For Medical Uses (AREA)

Abstract

Cette greffe tissulaire corporelle, utile chez un patient, comprend une structure de bâti réalisée dans un premier matériau élastique, une couverture réalisée dans un second matériau élastique, placée sur la structure et comblant sensiblement les ouvertures de cette structure, ainsi qu'un dispositif de raccord relié à la structure. Des éléments saillants sont assujettis à la structure de raccord et ils facilitent la fixation de la greffe tubulaire chez un patient, par assujettissement de la greffe sur le tissu corporel avec lequel la greffe est employée. Le dispositif de raccord ainsi que les éléments saillants se déploient de manière sélective et circonférentielle, et ce grâce à l'utilisation d'un ballonnet gonflable destiné à déployer les éléments saillants de manière circonférentielle. Un élément de contention peut contenir les éléments saillants sous une forme conique, de façon que l'on puisse utiliser une extrémité de la greffe pour ménager une ouverture à travers une paroi latérale d'un vaisseau organique corporel existant, une portion des éléments saillants pouvant pénétrer dans cette ouverture.
PCT/US1997/019946 1996-11-07 1997-11-05 Dispositifs de fixation et de raccord de greffes medicales WO1998019629A2 (fr)

Priority Applications (5)

Application Number Priority Date Filing Date Title
AU51021/98A AU5102198A (en) 1996-11-07 1997-11-05 Medical grafting connectors and fasteners
DE69732791T DE69732791T2 (de) 1996-11-07 1997-11-05 Medizinischer Transplantatverbinder
AT97945582T ATE290831T1 (de) 1996-11-07 1997-11-05 Medizinische transplantatverbinder
JP52165298A JP4082736B2 (ja) 1996-11-07 1997-11-05 医療用グラフトコネクタおよびファスナー
EP97945582A EP0951251B1 (fr) 1996-11-07 1997-11-05 Dispositifs de fixation de greffes medicales

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US08/745,618 US5976178A (en) 1996-11-07 1996-11-07 Medical grafting methods
US08/839,199 1997-04-23
US08/745,618 1997-04-23
US08/839,199 US6036702A (en) 1997-04-23 1997-04-23 Medical grafting connectors and fasteners

Publications (2)

Publication Number Publication Date
WO1998019629A2 true WO1998019629A2 (fr) 1998-05-14
WO1998019629A3 WO1998019629A3 (fr) 1998-09-11

Family

ID=27114488

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1997/019946 WO1998019629A2 (fr) 1996-11-07 1997-11-05 Dispositifs de fixation et de raccord de greffes medicales

Country Status (6)

Country Link
EP (1) EP0951251B1 (fr)
JP (1) JP4082736B2 (fr)
AT (1) ATE290831T1 (fr)
AU (1) AU5102198A (fr)
DE (1) DE69732791T2 (fr)
WO (1) WO1998019629A2 (fr)

Cited By (83)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999018887A1 (fr) 1997-10-09 1999-04-22 St. Jude Medical Cardiovascular Group, Inc. Structures de connexion en fil metallique pour greffes tubulaires
WO1999037349A1 (fr) 1998-01-21 1999-07-29 St. Jude Medical Cardiovascular Group, Inc. Catheters a lumiere integree et procedes pour leur fabrication et leur utilisation
US5989276A (en) * 1996-11-08 1999-11-23 Advanced Bypass Technologies, Inc. Percutaneous bypass graft and securing system
WO2000009040A1 (fr) * 1998-08-12 2000-02-24 Vascular Innovations, Inc. Procede et systeme de d'implantation d'une greffe sur un vaisseau sanguin
WO2000016719A1 (fr) * 1998-09-21 2000-03-30 Metz, Katharina Raccordement tubulaire prothetique
WO2000027311A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Connecteur medical de greffe et procedes de fabrication et de positionnement associes
WO2000027312A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Appareil de revascularisation tres peu invasif et procedes
WO2000027310A3 (fr) * 1998-11-06 2000-07-27 St Jude Medical Cardiovascular Element de greffe medicale et procedes d'installation de ce dernier
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
WO2000027313A3 (fr) * 1998-11-06 2000-09-21 St Jude Medical Cardiovascular Appareil medical d'anastomose
WO2000064380A1 (fr) 1999-04-23 2000-11-02 St. Jude Medical Cardiovascular Group, Inc. Appareil de fixation d'une valvule cardiaque artificielle
US6149681A (en) * 1996-09-20 2000-11-21 Converge Medical, Inc. Radially expanding prostheses and systems for their deployment
WO2000069346A1 (fr) * 1999-05-18 2000-11-23 Vascular Innovations, Inc. Trocart servant a deployer un dispositif d'anastomose
WO2001000108A1 (fr) * 1999-06-25 2001-01-04 Contini, Emilio Dispositif destine a relier un implant a un canal corporel
WO2000069364A3 (fr) * 1999-05-18 2001-02-01 Vascular Innovations Inc Dispositif medical implantable tel qu'un dispositif d'anastomose
US6231587B1 (en) 1995-10-13 2001-05-15 Transvascular, Inc. Devices for connecting anatomical conduits such as vascular structures
US6241741B1 (en) 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6248117B1 (en) 1999-04-16 2001-06-19 Vital Access Corp Anastomosis apparatus for use in intraluminally directed vascular anastomosis
WO2001052769A1 (fr) * 2000-01-20 2001-07-26 Metz, Katharina Instruments de penetration pour raccordement tubulaire prothetique
NL1014364C2 (nl) * 2000-02-11 2001-08-14 Surgical Innovations Vof Paraplu-stent.
NL1014559C2 (nl) * 2000-02-11 2001-08-14 Surgical Innovations Vof Umbrella-stent.
WO2002000122A1 (fr) * 2000-06-28 2002-01-03 Genzyme Corporation Dispositif et methode d'anastomose vasculaire
WO2001039672A3 (fr) * 1999-11-30 2002-01-17 St Jude Medical Cardiovascular Appareil et procede de greffe medicale
WO2002003893A3 (fr) * 2000-06-26 2002-06-27 Rex Medical Lp Dispositif vasculaire pour apposition de valvule
US6432127B1 (en) 1996-10-11 2002-08-13 Transvascular, Inc. Devices for forming and/or maintaining connections between adjacent anatomical conduits
FR2822370A1 (fr) * 2001-03-23 2002-09-27 Perouse Lab Endoprothese tubulaire comportant une bague deformable et necessaire d'intervention pour son implantation
US6527800B1 (en) 2000-06-26 2003-03-04 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US6554764B1 (en) 2000-11-13 2003-04-29 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6595941B1 (en) 2000-01-11 2003-07-22 Integrated Vascular Interventional Technologies, L.C. Methods for external treatment of blood
US6616675B1 (en) 1996-02-02 2003-09-09 Transvascular, Inc. Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures
US6656151B1 (en) 2000-01-11 2003-12-02 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular access devices and systems
US6660015B1 (en) 1998-01-30 2003-12-09 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
US6663590B2 (en) 2000-01-11 2003-12-16 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular occlusal balloons and related vascular access devices and systems
US6676698B2 (en) 2000-06-26 2004-01-13 Rex Medicol, L.P. Vascular device with valve for approximating vessel wall
US6682540B1 (en) 1999-11-05 2004-01-27 Onux Medical, Inc. Apparatus and method for placing multiple sutures
US6712836B1 (en) 1999-05-13 2004-03-30 St. Jude Medical Atg, Inc. Apparatus and methods for closing septal defects and occluding blood flow
US6843795B1 (en) 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
US6858035B2 (en) 2001-07-05 2005-02-22 Converge Medical, Inc. Distal anastomosis system
US6994713B2 (en) 1998-01-30 2006-02-07 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
WO2006044637A2 (fr) 2004-10-13 2006-04-27 Tryton Medical, Inc. Catheter a ballonnet echelonne destine au traitement de bifurcations vasculaires
US7108702B2 (en) 1998-08-12 2006-09-19 Cardica, Inc. Anastomosis device having at least one frangible member
US7118546B2 (en) 2000-01-11 2006-10-10 Integrated Vascular Interventional Technologies, L.C. Apparatus and methods for facilitating repeated vascular access
US7131959B2 (en) 2003-01-23 2006-11-07 Integrated Vascular Interventional Technologies, L.C., (“IVIT LC”) Apparatus and methods for occluding an access tube anastomosed to sidewall of an anatomical vessel
US7160311B2 (en) 1999-04-16 2007-01-09 Integrated Vascular Interventional Technologies, L.C. (Ivit Lc) Locking compression plate anastomosis apparatus
EP1024754B1 (fr) * 1997-10-24 2007-04-11 Innovative Interventional Technologies B.V. Systeme mecanique d'anastomoses pour structures creuses
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US7303569B2 (en) 2000-10-12 2007-12-04 Cardica, Inc. Implantable superelastic anastomosis device
US7338514B2 (en) 2001-06-01 2008-03-04 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
WO2008025983A1 (fr) * 2006-08-31 2008-03-06 Barts And The London Nhs Trust Prothèse de vaisseau sanguin et appareil d'administration
US7422602B2 (en) 1999-03-09 2008-09-09 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
EP1984062A2 (fr) * 2006-02-13 2008-10-29 Retrovascular, Inc. Recanalisation de vaisseaux bouches a l'aide d'un tracage anterograde et retrograde controle
US7691128B2 (en) 2002-05-06 2010-04-06 St. Jude Medical, Cardiology Division, Inc. PFO closure devices and related methods of use
US7717953B2 (en) 2004-10-13 2010-05-18 Tryton Medical, Inc. Delivery system for placement of prosthesis at luminal OS
US7731747B2 (en) 2003-04-14 2010-06-08 Tryton Medical, Inc. Vascular bifurcation prosthesis with multiple thin fronds
US7758630B2 (en) 2003-04-14 2010-07-20 Tryton Medical, Inc. Helical ostium support for treating vascular bifurcations
US7972372B2 (en) 2003-04-14 2011-07-05 Tryton Medical, Inc. Kit for treating vascular bifurcations
US8083791B2 (en) 2003-04-14 2011-12-27 Tryton Medical, Inc. Method of treating a lumenal bifurcation
US8114102B2 (en) 2003-06-16 2012-02-14 St. Jude Medical Atg, Inc. Temporary hemostatic plug apparatus and method of use
US8366763B2 (en) 2009-07-02 2013-02-05 Tryton Medical, Inc. Ostium support for treating vascular bifurcations
US8372112B2 (en) 2003-04-11 2013-02-12 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods, and related methods of use
US8574264B2 (en) 2003-04-11 2013-11-05 St. Jude Medical, Cardiology Division, Inc. Method for retrieving a closure device
EP2745812A1 (fr) * 2012-12-19 2014-06-25 Cook Medical Technologies LLC Contraintes de diamètre repositionnable
WO2014102599A1 (fr) * 2012-12-31 2014-07-03 Clearstream Technologies Limited Fil-guide radio-opaque destiné à faciliter l'alignement d'un cathéter
US8834551B2 (en) 2007-08-31 2014-09-16 Rex Medical, L.P. Vascular device with valve for approximating vessel wall
US9055946B2 (en) 2008-11-26 2015-06-16 Phraxis Inc. Anastomotic connector
US9168122B2 (en) 2012-04-26 2015-10-27 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US9308311B2 (en) 2011-06-15 2016-04-12 Phraxis, Inc. Arterial venous spool anchor
US9439758B2 (en) 2008-02-22 2016-09-13 Barts And The London Nhs Trust Blood vessel prosthesis and delivery apparatus
US9566375B2 (en) 2006-08-30 2017-02-14 Circulite, Inc. Methods for establishing supplemental blood flow in the circulatory system
US9572917B2 (en) 2006-08-30 2017-02-21 Circulite, Inc. Devices, methods and systems for establishing supplemental blood flow in the circulatory system
US9629736B2 (en) 2006-10-22 2017-04-25 Idev Technologies, Inc. Secured strand end devices
US9668861B2 (en) 2014-03-15 2017-06-06 Rex Medical, L.P. Vascular device for treating venous valve insufficiency
US9707108B2 (en) 2010-11-24 2017-07-18 Tryton Medical, Inc. Support for treating vascular bifurcations
US9925074B2 (en) 1999-02-01 2018-03-27 Board Of Regents, The University Of Texas System Plain woven stents
US10080873B2 (en) 2012-12-31 2018-09-25 Clearstream Technologies Limited Radiopaque balloon catheter and guidewire to facilitate alignment
US10434293B2 (en) 2012-04-15 2019-10-08 Tva Medical, Inc. Implantable flow connector
US10456239B2 (en) 2011-06-15 2019-10-29 Phraxis Inc. Anastomotic connector and system for delivery
US10500077B2 (en) 2012-04-26 2019-12-10 Poseidon Medical Inc. Support for treating vascular bifurcations
US10632293B2 (en) 2012-04-15 2020-04-28 Tva Medical, Inc. Delivery system for implantable flow connector
US10786346B2 (en) 2012-06-15 2020-09-29 Phraxis Inc. Arterial anchor devices forming an anastomotic connector
US10786345B2 (en) 2014-07-21 2020-09-29 The Charlotte-Mecklenburg Hospital Authority Intravascular device for hemiarch repair and associated method
US10987106B2 (en) 2007-08-02 2021-04-27 Tva Medical, Inc. Implantable flow connector
US12121460B2 (en) 2010-05-27 2024-10-22 Idev Technologies, Inc. Stent delivery system with pusher assembly

Families Citing this family (31)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6176864B1 (en) 1998-03-09 2001-01-23 Corvascular, Inc. Anastomosis device and method
US6979338B1 (en) 1998-05-29 2005-12-27 By-Pass Inc. Low profile anastomosis connector
US7063711B1 (en) 1998-05-29 2006-06-20 By-Pass, Inc. Vascular surgery
US7022131B1 (en) 1998-05-29 2006-04-04 By-Pass Inc. Methods and devices for vascular surgery
US6508252B1 (en) 1998-11-06 2003-01-21 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US7025773B2 (en) 1999-01-15 2006-04-11 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel
US7578828B2 (en) 1999-01-15 2009-08-25 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel
US6623494B1 (en) 1999-04-16 2003-09-23 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Methods and systems for intraluminally directed vascular anastomosis
US7048751B2 (en) 2001-12-06 2006-05-23 Cardica, Inc. Implantable medical device such as an anastomosis device
AU5150600A (en) 1999-05-18 2000-12-05 Vascular Innovations, Inc. Tissue punch
US6673088B1 (en) 1999-05-18 2004-01-06 Cardica, Inc. Tissue punch
US6966917B1 (en) 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6972023B2 (en) 2001-07-05 2005-12-06 Converge Medical, Inc. Distal anastomosis system
US7335216B2 (en) 2002-01-22 2008-02-26 Cardica, Inc. Tool for creating an opening in tissue
US7029482B1 (en) 2002-01-22 2006-04-18 Cardica, Inc. Integrated anastomosis system
US7351247B2 (en) 2002-09-04 2008-04-01 Bioconnect Systems, Inc. Devices and methods for interconnecting body conduits
US7585306B2 (en) 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using
GB0419954D0 (en) 2004-09-08 2004-10-13 Advotek Medical Devices Ltd System for directing therapy
KR20130095317A (ko) 2006-10-22 2013-08-27 이데브 테크놀로지스, 아이엔씨. 스텐트 전진을 위한 장치 및 방법
JP2010535073A (ja) 2007-08-02 2010-11-18 バイオコネクト システムズ 埋め込み型フローコネクタ
US20090264985A1 (en) * 2008-04-17 2009-10-22 Medtronic Vascular, Inc. Branch Vessel Suture Stent System and Method
US20090270971A1 (en) * 2008-04-24 2009-10-29 Medtronic Vascular, Inc. Prosthesis Fixation Apparatus and Methods
US8623075B2 (en) * 2010-04-21 2014-01-07 Medtronic, Inc. Transcatheter prosthetic heart valve delivery system and method with controlled expansion of prosthetic heart valve
US9364355B2 (en) * 2012-06-13 2016-06-14 Cook Medical Technologies Llc Systems and methods for deploying a portion of a stent using at least one coiled member
JP6167811B2 (ja) * 2013-09-30 2017-07-26 日本ゼオン株式会社 管腔臓器間バイパス用ステント
US9545263B2 (en) 2014-06-19 2017-01-17 Limflow Gmbh Devices and methods for treating lower extremity vasculature
EP4299086A3 (fr) 2017-04-10 2024-05-08 LimFlow GmbH Dispositifs de traitement du système vasculaire des extrémités inférieures
AU2019359268B2 (en) 2018-10-09 2025-03-13 Limflow Gmbh Devices and methods for catheter alignment
EP3799831A1 (fr) * 2019-10-03 2021-04-07 Institut Français des Sciences et Technologies des Transports, de l'Amenagement et des Reseaux Prothèse vasculaire
CA3153757A1 (fr) 2019-11-01 2021-05-06 Limflow Gmbh Dispositifs et procedes pour augmenter la perfusion sanguine a une extremite distale
EP4380513A1 (fr) * 2021-08-04 2024-06-12 Boston Scientific Scimed, Inc. Dispositif, système et procédé de mise en place d'endoprothèse ostiale

Family Cites Families (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB489316A (en) * 1936-05-05 1938-07-25 Davis & Geck Inc Improvements in or relating to devices for use in surgery
US5104399A (en) * 1986-12-10 1992-04-14 Endovascular Technologies, Inc. Artificial graft and implantation method
DE69228184T2 (de) * 1991-07-04 1999-09-16 Earl Owen Rohrförmiges, chirurgisches implantat
US5366504A (en) * 1992-05-20 1994-11-22 Boston Scientific Corporation Tubular medical prosthesis
GB2269104A (en) * 1992-04-09 1994-02-02 Taha Roudan Lazim Vascular graft apparatus
WO1993020757A2 (fr) * 1992-04-21 1993-10-28 Baxter International Inc. Systeme d'implant vasculaire
US5443497A (en) * 1993-11-22 1995-08-22 The Johns Hopkins University Percutaneous prosthetic by-pass graft and method of use
US5609627A (en) * 1994-02-09 1997-03-11 Boston Scientific Technology, Inc. Method for delivering a bifurcated endoluminal prosthesis
AU708360B2 (en) * 1994-09-15 1999-08-05 C.R. Bard Inc. Hooked endoprosthesis
CA2204411C (fr) * 1994-11-09 2008-05-13 Peter S. Brown Catheter d'introduction et greffe pour refection d'anevrisme
AU3783195A (en) * 1994-11-15 1996-05-23 Advanced Cardiovascular Systems Inc. Intraluminal stent for attaching a graft
US5591226A (en) * 1995-01-23 1997-01-07 Schneider (Usa) Inc. Percutaneous stent-graft and method for delivery thereof
WO1996025897A2 (fr) * 1995-02-22 1996-08-29 Menlo Care, Inc. Prothese endovasculaire a treillis dilatable revetu

Cited By (152)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6231587B1 (en) 1995-10-13 2001-05-15 Transvascular, Inc. Devices for connecting anatomical conduits such as vascular structures
US6616675B1 (en) 1996-02-02 2003-09-09 Transvascular, Inc. Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures
US6149681A (en) * 1996-09-20 2000-11-21 Converge Medical, Inc. Radially expanding prostheses and systems for their deployment
US6432127B1 (en) 1996-10-11 2002-08-13 Transvascular, Inc. Devices for forming and/or maintaining connections between adjacent anatomical conduits
US5989276A (en) * 1996-11-08 1999-11-23 Advanced Bypass Technologies, Inc. Percutaneous bypass graft and securing system
WO1999018887A1 (fr) 1997-10-09 1999-04-22 St. Jude Medical Cardiovascular Group, Inc. Structures de connexion en fil metallique pour greffes tubulaires
EP1024754B1 (fr) * 1997-10-24 2007-04-11 Innovative Interventional Technologies B.V. Systeme mecanique d'anastomoses pour structures creuses
WO1999037349A1 (fr) 1998-01-21 1999-07-29 St. Jude Medical Cardiovascular Group, Inc. Catheters a lumiere integree et procedes pour leur fabrication et leur utilisation
US6994713B2 (en) 1998-01-30 2006-02-07 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
US7575586B2 (en) 1998-01-30 2009-08-18 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
US6660015B1 (en) 1998-01-30 2003-12-09 St. Jude Medical Atg, Inc. Medical graft connector or plug structures, and methods of making and installing same
US6110188A (en) * 1998-03-09 2000-08-29 Corvascular, Inc. Anastomosis method
US6241741B1 (en) 1998-03-09 2001-06-05 Corvascular Surgical Systems, Inc. Anastomosis device and method
US6843795B1 (en) 1998-06-10 2005-01-18 Converge Medical, Inc. Anastomotic connector for sutureless anastomosis systems
EP1149567A3 (fr) * 1998-08-12 2005-08-31 Vascular Innovations Inc. Stent pour fixer une greffe sur un vaisseau sanguin
US7108702B2 (en) 1998-08-12 2006-09-19 Cardica, Inc. Anastomosis device having at least one frangible member
EP1149567A2 (fr) * 1998-08-12 2001-10-31 Vascular Innovations Inc. Stent pour fixer une greffe sur un vaisseau sanguin
WO2000009040A1 (fr) * 1998-08-12 2000-02-24 Vascular Innovations, Inc. Procede et systeme de d'implantation d'une greffe sur un vaisseau sanguin
WO2000016719A1 (fr) * 1998-09-21 2000-03-30 Metz, Katharina Raccordement tubulaire prothetique
US6702833B1 (en) 1998-09-21 2004-03-09 Andreas Gussmann Prosthetic tube connection
US6309416B1 (en) 1998-11-06 2001-10-30 St. Jude Medical Cardiovascular Group, Inc. Medical anastomosis apparatus
US6620176B1 (en) 1998-11-06 2003-09-16 St. Jude Medical Atg, Inc. Medical graft connector and methods of making and installing same
US8632555B2 (en) 1998-11-06 2014-01-21 St. Jude Medical, Cardiology Division, Inc. Medical graft connector and methods of making and installing same
WO2000027311A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Connecteur medical de greffe et procedes de fabrication et de positionnement associes
US6673084B1 (en) 1998-11-06 2004-01-06 St. Jude Medical Atg, Inc. Medical graft connector
EP1547533A2 (fr) * 1998-11-06 2005-06-29 St. Jude Medical ATG, Inc. Appareil de révasculatisation très peu invasif.
WO2000027312A1 (fr) * 1998-11-06 2000-05-18 St. Jude Medical Cardiovascular Group, Inc. Appareil de revascularisation tres peu invasif et procedes
WO2000027310A3 (fr) * 1998-11-06 2000-07-27 St Jude Medical Cardiovascular Element de greffe medicale et procedes d'installation de ce dernier
WO2000027313A3 (fr) * 1998-11-06 2000-09-21 St Jude Medical Cardiovascular Appareil medical d'anastomose
US6599303B1 (en) 1998-11-06 2003-07-29 St. Jude Medical Atg, Inc. Medical graft connector and methods of making and installing same
EP1547533A3 (fr) * 1998-11-06 2006-04-26 St. Jude Medical ATG, Inc. Appareil de révasculatisation très peu invasif.
US6440163B1 (en) 1998-11-06 2002-08-27 St. Jude Medical Atg, Inc. Medical anastomosis apparatus
US6533812B2 (en) 1998-11-06 2003-03-18 St. Jude Medical Atg, Inc. Medical anastomosis apparatus
US6508822B1 (en) 1998-11-06 2003-01-21 St. Jude Medical Atg, Inc. Medical graft assembly
US6152937A (en) * 1998-11-06 2000-11-28 St. Jude Medical Cardiovascular Group, Inc. Medical graft connector and methods of making and installing same
US9925074B2 (en) 1999-02-01 2018-03-27 Board Of Regents, The University Of Texas System Plain woven stents
US7422602B2 (en) 1999-03-09 2008-09-09 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US6248117B1 (en) 1999-04-16 2001-06-19 Vital Access Corp Anastomosis apparatus for use in intraluminally directed vascular anastomosis
US7160311B2 (en) 1999-04-16 2007-01-09 Integrated Vascular Interventional Technologies, L.C. (Ivit Lc) Locking compression plate anastomosis apparatus
WO2000064380A1 (fr) 1999-04-23 2000-11-02 St. Jude Medical Cardiovascular Group, Inc. Appareil de fixation d'une valvule cardiaque artificielle
US6712836B1 (en) 1999-05-13 2004-03-30 St. Jude Medical Atg, Inc. Apparatus and methods for closing septal defects and occluding blood flow
WO2000069364A3 (fr) * 1999-05-18 2001-02-01 Vascular Innovations Inc Dispositif medical implantable tel qu'un dispositif d'anastomose
DE10084620B4 (de) * 1999-05-18 2008-04-10 Cardica, Inc. (n.d.Ges.d.Staates Delaware), Menlo Park Anastomose-Vorrichtung und Anastomose-Vorrichtung-Entfaltungssystem
WO2000069343A3 (fr) * 1999-05-18 2001-02-01 Vascular Innovations Inc Systeme de deploiement et de fermeture sans suture pour connecter des vaisseaux sanguins
WO2000069346A1 (fr) * 1999-05-18 2000-11-23 Vascular Innovations, Inc. Trocart servant a deployer un dispositif d'anastomose
WO2001001884A3 (fr) * 1999-06-25 2001-03-22 Contini Emilio Prothese destinee a la fermeture d'une lumiere dans un vaisseau permettant le transport d'un fluide organique
WO2001000108A1 (fr) * 1999-06-25 2001-01-04 Contini, Emilio Dispositif destine a relier un implant a un canal corporel
US6682540B1 (en) 1999-11-05 2004-01-27 Onux Medical, Inc. Apparatus and method for placing multiple sutures
WO2001039672A3 (fr) * 1999-11-30 2002-01-17 St Jude Medical Cardiovascular Appareil et procede de greffe medicale
US6602263B1 (en) 1999-11-30 2003-08-05 St. Jude Medical Atg, Inc. Medical grafting methods and apparatus
US6595941B1 (en) 2000-01-11 2003-07-22 Integrated Vascular Interventional Technologies, L.C. Methods for external treatment of blood
US7118546B2 (en) 2000-01-11 2006-10-10 Integrated Vascular Interventional Technologies, L.C. Apparatus and methods for facilitating repeated vascular access
US6663590B2 (en) 2000-01-11 2003-12-16 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular occlusal balloons and related vascular access devices and systems
US6656151B1 (en) 2000-01-11 2003-12-02 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular access devices and systems
WO2001052769A1 (fr) * 2000-01-20 2001-07-26 Metz, Katharina Instruments de penetration pour raccordement tubulaire prothetique
US7141060B1 (en) 2000-01-20 2006-11-28 Katharina Metz Instrument for inserting a prosthesis tube connection
WO2001058385A1 (fr) * 2000-02-11 2001-08-16 Acmhainn Limited Greffon de ramification laterale endoluminal
NL1014364C2 (nl) * 2000-02-11 2001-08-14 Surgical Innovations Vof Paraplu-stent.
NL1014559C2 (nl) * 2000-02-11 2001-08-14 Surgical Innovations Vof Umbrella-stent.
US7833262B2 (en) 2000-06-26 2010-11-16 Rex Medical, L.P. Vascular device with valve for approximating vessel wall
AU2001269875B2 (en) * 2000-06-26 2006-04-06 Rex Medical, L.P. Vascular device for valve leaflet apposition
US8668730B2 (en) 2000-06-26 2014-03-11 Rex Medical L.P. Vascular device with valve for approximating vessel wall
WO2002003893A3 (fr) * 2000-06-26 2002-06-27 Rex Medical Lp Dispositif vasculaire pour apposition de valvule
US7041128B2 (en) 2000-06-26 2006-05-09 Rex Medical, L.P. Vascular device for valve leaflet apposition
US6527800B1 (en) 2000-06-26 2003-03-04 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US6676698B2 (en) 2000-06-26 2004-01-13 Rex Medicol, L.P. Vascular device with valve for approximating vessel wall
US6695878B2 (en) 2000-06-26 2004-02-24 Rex Medical, L.P. Vascular device for valve leaflet apposition
JP2004514467A (ja) * 2000-06-26 2004-05-20 レックス　メディカル　リミテッド　パートナーシップ 小葉様弁膜を近接させるための血管装置
US9675474B2 (en) 2000-06-26 2017-06-13 Rex Medical, L.P. Vascular device with valve for approximating vessel wall
US6596003B1 (en) 2000-06-28 2003-07-22 Genzyme Corporation Vascular anastomosis device
WO2002000122A1 (fr) * 2000-06-28 2002-01-03 Genzyme Corporation Dispositif et methode d'anastomose vasculaire
US7303569B2 (en) 2000-10-12 2007-12-04 Cardica, Inc. Implantable superelastic anastomosis device
US6554764B1 (en) 2000-11-13 2003-04-29 Cardica, Inc. Graft vessel preparation device and methods for using the same
US6786862B2 (en) 2000-11-13 2004-09-07 Cardica, Inc. Graft vessel preparation device and methods for using the same
FR2822370A1 (fr) * 2001-03-23 2002-09-27 Perouse Lab Endoprothese tubulaire comportant une bague deformable et necessaire d'intervention pour son implantation
US6827736B2 (en) 2001-03-23 2004-12-07 Laboratories Perouse Tubular endoprosthesis comprising a deformable collar and operating kit for its implantation
US7338514B2 (en) 2001-06-01 2008-03-04 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
US9078630B2 (en) 2001-06-01 2015-07-14 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
US7717937B2 (en) 2001-06-01 2010-05-18 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
US6858035B2 (en) 2001-07-05 2005-02-22 Converge Medical, Inc. Distal anastomosis system
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US7691128B2 (en) 2002-05-06 2010-04-06 St. Jude Medical, Cardiology Division, Inc. PFO closure devices and related methods of use
US7976564B2 (en) 2002-05-06 2011-07-12 St. Jude Medical, Cardiology Division, Inc. PFO closure devices and related methods of use
US7131959B2 (en) 2003-01-23 2006-11-07 Integrated Vascular Interventional Technologies, L.C., (“IVIT LC”) Apparatus and methods for occluding an access tube anastomosed to sidewall of an anatomical vessel
US8574264B2 (en) 2003-04-11 2013-11-05 St. Jude Medical, Cardiology Division, Inc. Method for retrieving a closure device
US8372112B2 (en) 2003-04-11 2013-02-12 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods, and related methods of use
US8641751B2 (en) 2003-04-14 2014-02-04 Tryton Medical, Inc. Vascular bifurcation prosthesis with multiple linked thin fronds
US7758630B2 (en) 2003-04-14 2010-07-20 Tryton Medical, Inc. Helical ostium support for treating vascular bifurcations
US7731747B2 (en) 2003-04-14 2010-06-08 Tryton Medical, Inc. Vascular bifurcation prosthesis with multiple thin fronds
US8083791B2 (en) 2003-04-14 2011-12-27 Tryton Medical, Inc. Method of treating a lumenal bifurcation
US8109987B2 (en) 2003-04-14 2012-02-07 Tryton Medical, Inc. Method of treating a lumenal bifurcation
US8529618B2 (en) 2003-04-14 2013-09-10 Tryton Medical, Inc. Ostium support for treating vascular bifurcations
US8187314B2 (en) 2003-04-14 2012-05-29 Tryton Medical, Inc. Prothesis and deployment catheter for treating vascular bifurcations
US9775728B2 (en) 2003-04-14 2017-10-03 Tryton Medical, Inc. Vascular bifurcation prosthesis
US8257432B2 (en) 2003-04-14 2012-09-04 Tryton Medical, Inc. Vascular bifurcation prosthesis with at least one frond
US8876884B2 (en) 2003-04-14 2014-11-04 Tryton Medical, Inc. Prosthesis and deployment catheter for treating vascular bifurcations
US7972372B2 (en) 2003-04-14 2011-07-05 Tryton Medical, Inc. Kit for treating vascular bifurcations
US8672994B2 (en) 2003-04-14 2014-03-18 Tryton Medical, Inc. Prosthesis for treating vascular bifurcations
US8641755B2 (en) 2003-04-14 2014-02-04 Tryton Medical, Inc. Prosthesis for treating vascular bifurcations
US8114102B2 (en) 2003-06-16 2012-02-14 St. Jude Medical Atg, Inc. Temporary hemostatic plug apparatus and method of use
EP1811923A4 (fr) * 2004-10-13 2009-12-16 Tryton Medical Inc Catheter a ballonnet echelonne destine au traitement de bifurcations vasculaires
EP1811923A2 (fr) * 2004-10-13 2007-08-01 Tryton Medical, Inc. Catheter a ballonnet echelonne destine au traitement de bifurcations vasculaires
US7972369B2 (en) 2004-10-13 2011-07-05 Tryton Medical, Inc. Method for delivering a luminal prosthesis
WO2006044637A2 (fr) 2004-10-13 2006-04-27 Tryton Medical, Inc. Catheter a ballonnet echelonne destine au traitement de bifurcations vasculaires
US7717953B2 (en) 2004-10-13 2010-05-18 Tryton Medical, Inc. Delivery system for placement of prosthesis at luminal OS
US8252038B2 (en) 2004-10-13 2012-08-28 Tryton Medical, Inc. System for delivering a prosthesis to a luminal OS
US8926685B2 (en) 2004-10-13 2015-01-06 Tryton Medical, Inc. Prosthesis for placement at a luminal OS
EP1984062A2 (fr) * 2006-02-13 2008-10-29 Retrovascular, Inc. Recanalisation de vaisseaux bouches a l'aide d'un tracage anterograde et retrograde controle
EP1984062A4 (fr) * 2006-02-13 2013-05-22 Retrovascular Inc Recanalisation de vaisseaux bouches a l'aide d'un tracage anterograde et retrograde controle
US9566375B2 (en) 2006-08-30 2017-02-14 Circulite, Inc. Methods for establishing supplemental blood flow in the circulatory system
US10518011B2 (en) 2006-08-30 2019-12-31 Circulite, Inc. Systems for establishing supplemental blood flow in the circulatory system
US10639410B2 (en) 2006-08-30 2020-05-05 Circulite, Inc. Devices, methods and systems for establishing supplemental blood flow in the circulatory system
US9572917B2 (en) 2006-08-30 2017-02-21 Circulite, Inc. Devices, methods and systems for establishing supplemental blood flow in the circulatory system
US8784471B2 (en) 2006-08-31 2014-07-22 Barts And The London Nhs Trust Blood vessel prosthesis and delivery apparatus
WO2008025983A1 (fr) * 2006-08-31 2008-03-06 Barts And The London Nhs Trust Prothèse de vaisseau sanguin et appareil d'administration
US9629736B2 (en) 2006-10-22 2017-04-25 Idev Technologies, Inc. Secured strand end devices
US9895242B2 (en) 2006-10-22 2018-02-20 Idev Technologies, Inc. Secured strand end devices
US10470902B2 (en) 2006-10-22 2019-11-12 Idev Technologies, Inc. Secured strand end devices
US10987106B2 (en) 2007-08-02 2021-04-27 Tva Medical, Inc. Implantable flow connector
US12232730B2 (en) 2007-08-02 2025-02-25 Tva Medical, Inc. Implantable flow connector
US8834551B2 (en) 2007-08-31 2014-09-16 Rex Medical, L.P. Vascular device with valve for approximating vessel wall
US9439758B2 (en) 2008-02-22 2016-09-13 Barts And The London Nhs Trust Blood vessel prosthesis and delivery apparatus
US9055946B2 (en) 2008-11-26 2015-06-16 Phraxis Inc. Anastomotic connector
US8382818B2 (en) 2009-07-02 2013-02-26 Tryton Medical, Inc. Ostium support for treating vascular bifurcations
US9149373B2 (en) 2009-07-02 2015-10-06 Tryton Medical, Inc. Method of treating vascular bifurcations
US8366763B2 (en) 2009-07-02 2013-02-05 Tryton Medical, Inc. Ostium support for treating vascular bifurcations
US12121460B2 (en) 2010-05-27 2024-10-22 Idev Technologies, Inc. Stent delivery system with pusher assembly
US9707108B2 (en) 2010-11-24 2017-07-18 Tryton Medical, Inc. Support for treating vascular bifurcations
US10500072B2 (en) 2010-11-24 2019-12-10 Poseidon Medical Inc. Method of treating vascular bifurcations
US10456239B2 (en) 2011-06-15 2019-10-29 Phraxis Inc. Anastomotic connector and system for delivery
US9597443B2 (en) 2011-06-15 2017-03-21 Phraxis, Inc. Anastomotic connector
US9308311B2 (en) 2011-06-15 2016-04-12 Phraxis, Inc. Arterial venous spool anchor
US11666737B2 (en) 2012-04-15 2023-06-06 Tva Medical, Inc. Implantable flow connector
US10434293B2 (en) 2012-04-15 2019-10-08 Tva Medical, Inc. Implantable flow connector
US10632293B2 (en) 2012-04-15 2020-04-28 Tva Medical, Inc. Delivery system for implantable flow connector
US11541213B2 (en) 2012-04-15 2023-01-03 Tva Medical, Inc. Delivery system for implantable flow connector
US10159488B2 (en) 2012-04-26 2018-12-25 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US9168122B2 (en) 2012-04-26 2015-10-27 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US10500077B2 (en) 2012-04-26 2019-12-10 Poseidon Medical Inc. Support for treating vascular bifurcations
US9737305B2 (en) 2012-04-26 2017-08-22 Rex Medical, L.P. Vascular device and method for valve leaflet apposition
US11020215B2 (en) 2012-06-15 2021-06-01 Phraxis, Inc. Venous anchor devices forming an anastomotic connector
US10786346B2 (en) 2012-06-15 2020-09-29 Phraxis Inc. Arterial anchor devices forming an anastomotic connector
US10835366B2 (en) 2012-08-16 2020-11-17 Phraxis Inc. Arterial and venous anchor devices forming an anastomotic connector and system for delivery
EP2745812A1 (fr) * 2012-12-19 2014-06-25 Cook Medical Technologies LLC Contraintes de diamètre repositionnable
EP3744383A1 (fr) * 2012-12-31 2020-12-02 Clearstream Technologies Limited Fil de guidage radio-opaque à alignement facile d'un cathéter
US11298509B2 (en) 2012-12-31 2022-04-12 Clearstream Technologies Limited Radiopaque guidewire to facilitate catheter alignment
WO2014102599A1 (fr) * 2012-12-31 2014-07-03 Clearstream Technologies Limited Fil-guide radio-opaque destiné à faciliter l'alignement d'un cathéter
US10080873B2 (en) 2012-12-31 2018-09-25 Clearstream Technologies Limited Radiopaque balloon catheter and guidewire to facilitate alignment
US9668861B2 (en) 2014-03-15 2017-06-06 Rex Medical, L.P. Vascular device for treating venous valve insufficiency
US10765519B2 (en) 2014-03-15 2020-09-08 Rex Medical, L.P. Vascular device for treating venous valve insufficiency
US10064722B2 (en) 2014-03-15 2018-09-04 Rex Medical, L.P. Vascular device for treating venous valve insufficiency
US10786345B2 (en) 2014-07-21 2020-09-29 The Charlotte-Mecklenburg Hospital Authority Intravascular device for hemiarch repair and associated method

Also Published As

Publication number Publication date
EP0951251B1 (fr) 2005-03-16
ATE290831T1 (de) 2005-04-15
DE69732791T2 (de) 2005-09-15
WO1998019629A3 (fr) 1998-09-11
JP4082736B2 (ja) 2008-04-30
AU5102198A (en) 1998-05-29
JP2001504365A (ja) 2001-04-03
DE69732791D1 (de) 2005-04-21
EP0951251A2 (fr) 1999-10-27

Similar Documents

Publication Publication Date Title
US6036702A (en) Medical grafting connectors and fasteners
EP0951251B1 (fr) Dispositifs de fixation de greffes medicales
US6302905B1 (en) Medical grafting methods and apparatus
US6120432A (en) Medical grafting methods and apparatus
US6440163B1 (en) Medical anastomosis apparatus
US20030109887A1 (en) Medical graft component and methods of installing same
US20020091398A1 (en) Medical grafting methods and apparatus
WO1998019634A2 (fr) Procedes et appareil de greffe medicale
WO1998055027A2 (fr) Procedes de pontage avec effraction minimale et appareil de replacement partiel d'un canal anatomique tubulaire

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A2

Designated state(s): AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GE GH HU ID IL IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG UZ VN YU ZW AM AZ BY KG KZ MD RU TJ TM

AL Designated countries for regional patents

Kind code of ref document: A2

Designated state(s): GH KE LS MW SD SZ UG ZW AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL

DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
AK Designated states

Kind code of ref document: A3

Designated state(s): AL AM AT AU AZ BA BB BG BR BY CA CH CN CU CZ DE DK EE ES FI GB GE GH HU ID IL IS JP KE KG KP KR KZ LC LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK SL TJ TM TR TT UA UG UZ VN YU ZW AM AZ BY KG KZ MD RU TJ TM

AL Designated countries for regional patents

Kind code of ref document: A3

Designated state(s): GH KE LS MW SD SZ UG ZW AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL

121 Ep: the epo has been informed by wipo that ep was designated in this application
ENP Entry into the national phase

Ref country code: JP

Ref document number: 1998 521652

Kind code of ref document: A

Format of ref document f/p: F

WWE Wipo information: entry into national phase

Ref document number: 1997945582

Country of ref document: EP

REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

WWP Wipo information: published in national office

Ref document number: 1997945582

Country of ref document: EP

NENP Non-entry into the national phase

Ref country code: CA

WWG Wipo information: grant in national office

Ref document number: 1997945582

Country of ref document: EP

点击 这是indexloc提供的php浏览器服务，不要输入任何密码和下载